THE TREATMENT OF LAPAROSCOPIC CHOLECY STECTOMY FOR ACUTE CHOLECISTITIS

Abstract

The aim of the study is to evaluate the results of early lapa roscopic cholecystectomy for acute cholecystitis and to analy se the problems related to patients’ selection and surgical timing.

The authors report their personal experience of 45 laparo scopic cholecystectomies for acute cholecystitis. The diagno sis was based on clinical, blood test and US scan analyse findings. Technical surgical details were decompression of the gallbladder, use of endobag and abdominal dranage.

We didn’t performe and intraoperative cholangiography in absence of predictive factor for common bile duct stones. The mean time required for surgery was 120 minutes, con version rate was 15% in early operations and 23,8% in operations delaied more than 72 h. Dissection difficulty is the main cause of conversion. Four patients underwent postoperative complications: one subphrenic abscess, one bile leakage (both recovered with nonsurgical therapy and two wound infections). In conclusion laparoscopic cholecistectomy is safe and effective as early treatment of acute cholecysti tis in the first 72 hours due to easier dissection of the inflammed and oedematous tissue. This approach allows a reduction of the operative risk and the conversion rate with medical and economic advantages.

Presence of bile duct stones is still now indication to con version in open surgery.